APPLICATION AND PROBLEMS OF BLUNT DISSECTION WITHOUT THORACOTOMY FOR CARCINOMA OF THORACIC ESOPHAGUS

Abstract

Sixteen cases of intrathoracic esophageal lesion on whom blunt dissection was carried out without thoracotomy were evaluated retrospectively for operative safety and adequacy of indications for intrathoracic esophageal carcinoma.
Results were as follows:
1) Blunt dissection without thoracotomy is safe in cases of intrathoracic esophageal lesion except for those with severe adventitial changes.
2) Blunt dissection is applicable for cases of reduced pulmonary function and those at high risk; therefore, the resectability rate may be increased. Blunt dissection should be considered if resection under thoracotomy is impossible, especially in cases in which cancer invasion is limitted to the lamina propria mucosae, because curative resection can be expected.
3) In other intrathoracic carcinoma cases in which resection under thoracotomy is not suitable because of impaired general condition or distant organ metastasis, blunt dissection may be acceptable given considerations of cancer reduction and/or avoiding such complications as bleeding. It is also important to compare the benefits and disadvantages of blunt dissection with those of other therapeutic methods for these cases in terms of the patient's prognosis and quality of life.